Healthcare Provider Details

I. General information

NPI: 1437221827
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 COUNTY CIRCLE DR
RIVERSIDE CA
92503-3410
US

IV. Provider business mailing address

PO BOX 7549
RIVERSIDE CA
92513-7549
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4613
  • Fax: 951-358-6868
Mailing address:
  • Phone: 951-358-6900
  • Fax: 951-358-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number00033
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. JERRY A WENGERD
Title or Position: DIRECTOR DEPARTMENT OF MENTAL HEAL
Credential:
Phone: 951-358-6900